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2 Foreword The nursing profession is no stranger to change. Transformation and growth are essential to our work as we endeavour to provide the best possible patient/client care in all health care settings. As professionals we must understand the latest technology in health and be tuned into research as best practice is constantly developed. All this takes place in a health system which is itself in the midst of huge reform. Social media is a revolutionary way to participate in developments and be informed of breaking news, events, discussions and discoveries that affect you. The question is not whether or not the nursing profession should embrace social media. It is embracing us; it is now part of the world we work in. The real question is: how can we use the power of social media to strengthen the nursing profession? So many opportunities exist for nurses through the appropriate use of social media. We can strengthen our individual roles across the health system through access to information and networking with other nurses and health professionals. We can ensure a positive connection and input to the changes that affect us, our patients/clients and the way we deliver nursing care. Ultimately, we have an opportunity to inspire, progress and promote the nursing profession through a strong online presence. There are, of course, dangers in social media, but RCNA believes that the benefits far outweigh the negatives. We ve put together these guidelines as a way to help nurses navigate the pitfalls and potential problems that can be faced while using social media. Keeping on the safe side is not difficult and is well worth the effort; RCNA hopes that these guidelines can help those who may be hesitant or overwhelmed at the scope of it all to harness the power that social media can offer the nursing profession. Debra Cerasa FRCNA FCN CEO RCNA October 2011 RCNA Social Media Guidelines for Nurses 1

3 Step 1: Maintain confidentiality online As a nurse it s common to discuss patient/client care and outcomes in professional and private settings. Nurses have an ethical and legal responsibility to maintain their patients /clients confidentiality. When talking about any patient/client care online for example; with friends on social networking sites or on public forums such as blogs, the same principles apply to those in a public setting. Before posting anything about patient/client care online, consider the reasons for doing so: For education purposes, the patient/client may need to be informed and offer their express consent. The obtainment of this consent should be acknowledged in any online posts. This does not differ to use of information in any other medium, for example photographs. For discussions involving a patient/client s care, ensure that the patient/client s identity is protected and that the patient/client situation cannot be identified by the sum of information available online. Breaching confidentiality can result in complaints to the Nursing and Midwifery Board of Australia (NMBA), involvement of the Privacy Commissioner, or even legal action. Below is an example of breaching confidentiality online: A nurse who runs a nurse education blog around skin conditions posted a case study relating to a patient with an unusual condition. Whilst the patient was never identified by name, a work colleague of the patient was searching the internet to research more information about the condition and was able to identify the patient through the information and pictures posted on the site. This post was reported to the hospital leading to the disciplinary action of the nurse involved as consent or permission had never been provided by the patient. Step 2: Avoid defamation Defamation is when comment spreads unfounded or misinformed reports about someone that could have negative connotations for the person. Some of the negative impacts of defamation could include a damaged reputation, tension in relationships with colleagues or an effect on the defamed person s work or profession. Defamation applies to all nursing settings, including social media. Some things to keep in mind about defamation when using social media include: To defame someone, you do not have to make up false things yourself. You might defame a person by repeating or replaying words spoken by someone else. More specifically, defamation can be defined as: o The publication of any false imputation concerning a person, or a member of his/her family, whether living or dead, by which (a) the reputation of that person is likely to be injured or (b) he/she is likely to be injured in his/her profession or trade or (c) other persons are likely to be induced to shun, avoid, ridicule or despise him/her. RCNA Social Media Guidelines for Nurses 2

4 o Publication of defamatory matter can be by (a) spoken words or audible sound or (b) words intended to be read by sight or touch or (c) signs, signals, gestures or visible representations, and must be done to a person other than the person defamed. Australia adopted unified defamation legislation across all states and territories with the Defamation Act Please refer to the relevant state legislation for further details if required. Here is an example of possible defamation posted on a social media site: The ICU team leader was such a cow today, she needed a female bed on our ward...then brought a different patient who was male... she has no idea about anything, I think they make her leader so she doesn t kill anyone!!! Step 3: Professional online boundaries Nurses need to ensure that they maintain a therapeutic relationship with their patients/clients. A therapeutic relationship can be defined as a relationship between a nurse and a patient/client built on a series of interactions and developing over time. All interactions do not develop into relationships but may nonetheless be therapeutic. The relationship differs from a social relationship in that it is designed to meet the needs only of the patient/client. Its structure varies with the context, the patient's needs, and the goals of the nurse and the patient/client. Its nature varies with the context, including the setting, the kind of nursing and the needs of the patient/client. Some points to keep in mind about professional online boundaries: It is recommended that nurses don t connect with or accept patients/clients or former patients/clients as friends on social media sites as they could be at risk of breaching therapeutic relationships. By allowing patients/clients to access personal or social sites you may be unaware of the insights that patients/clients might learn about you that may affect your professional relationship in the future. Here is an example based on an actual event: Nurse Smith is a community nurse who accepted a long-term wound care patient as a friend on a social media site. On the next visit to the patient s house, the patient commented on Nurse Smith s family and children through the photos on her site. Nurse Smith felt uncomfortable that the patient knew so much about her personal life and family. After the visit, Nurse Smith removed the patient as a friend. On her next visit to the house, the patient questioned Nurse Smith about why they were no longer friends on the social media site. RCNA Social Media Guidelines for Nurses 3

5 Step 4: Think about how you present yourself online More and more managers and employers are searching social media sites to find out information about possible employees. It s important that nurses maintain both their privacy and professionalism by carefully considering what comments, photos, profiles or blog related content they post on their social media site. Check list for nurses Go back to all your social media sites and ask yourself the following questions: Do the comments or posts reflect who you are as a professional? Can these posts be taken out of context? Are the photos of a nature that reflects how you want to be seen? Are your privacy settings suitable? Who can see your profile? Do your friends have any photos of you on their sites that you may be tagged in? Do these photos reflect how you want to be seen? Have you Google searched your own name? Does the search result reflect how you want to be seen? Step 5: Maintain online privacy Nurses need to ensure they maintain their online privacy. Here are some tips to help keep you safe online: Use built-in privacy and safety features When you register for a social networking account, you'll be asked for certain personal details and should be advised how this information will be used. If you have a public profile, it can be seen by anyone searching the social networking site and might also be available to people searching for profiles using a search engine. A private profile allows only invited friends and members of chosen networks to view your content. To help members interact safely with their friends online, many leading social networking sites provide privacy and safety information and tools. You can stay in control by using builtin features to allow only chosen people to view your profile and block unwanted approaches from someone in particular. You should also review your friends' list regularly and remove anyone you don't want to see your profile. Ask your friends and family not to post or tag photographs of, or information about you on their social network profiles without getting your permission first. This will help to keep you safe and your information secure. Use passwords and keep them secret Choose a complex password for your social networking profile. Avoid obvious passwords such as your children's or pet's name or your birthday and use different passwords for different websites. If you're using a public or shared computer to access your social networking site, cancel any auto login or remember me' functions and always make sure you log out at the end of your session. If you're accessing your profile from your mobile, set the phone's PIN code or activate the security lock, if you have one. The booklet you got with your handset should explain how to set this up. RCNA Social Media Guidelines for Nurses 4

6 Report any concerns you have Many of the leading social networking providers have reporting mechanisms and contact details on their websites so that you can report what has happened easily and quickly. Just look for the Help', Customer Care' or Report Abuse' buttons on the social networking sites. Breaches of a social networking provider's terms and conditions or community guidelines might include: sending offensive or bullying messages; posting embarrassing images; posting inappropriate content; setting up fake/imposter profiles. Check your privacy settings now. Conclusion Keeping these guidelines in mind, health care organisations can use social media options to communicate with staff, patients and the community at a whole new level. As the peak professional organisation for nurses, RCNA is committed to utilising social media to strengthen our organisation and in doing so, to inspire, progress and promote the nursing profession. Social media presents new opportunities at our fingertips. RCNA encourages you to explore how it can assist you in your contribution to the nursing profession. Some examples of professional use of social media: A short video for staff of the Department of Justice (Victoria, Australia) Best Hospital Facebook Pages Children s Hospitals Barwon Health Facebook Barwon Health Twitter Nothing contained in these materials is intended to be used as legal advice. RCNA does not accept any liability for any loss or damage incurred by use of or reliance on the information contained in these materials. RCNA makes every effort to ensure the quality of the information available in these materials. However, RCNA cannot guarantee and assumes no legal liability or responsibility for the accuracy, currency or completeness of the information. RCNA Social Media Guidelines for Nurses 5

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